Title

Author

Date of Award

Fall 12-22-2015

Degree Type

Final Project

Degree Name

DNP Doctor of Nursing Practice

Department

Nursing

Advisor

Mary Ellen Roberts, DNP

Committee Member

Eileen Toughill, Ph.D

Committee Member

Darilyn Paul

Abstract

Purpose: Pressure ulcers characterize a major health problem in clinical practice, which in turn, can have an impact on quality of life and health care costs (Dugaret, Videau, Faure, Gabinski, Bourdel-Marchasson & Salles, 2012). Pressure ulcers can develop during treatment regardless of the setting. They develop in long term facilities, family homes and hospitals. The purpose of this DNP project was to ensure patient health and safety by educating the primary emergency room nurses to at-risk individuals presenting to the Emergency Department and to initiate early intervention strategies. Significance of the Project: Until recently, there has been very little literature written on the prevalence and incidence rates of pressure ulcers in the Emergency Department (Dugaret, et al., 2012). This project will significantly impact an area of nursing, pressure ulcer prevention, considered a major nurse-sensitive outcome. Therefore, nursing care has a major effect on pressure ulcer development and prevention (Lyder & Ayello, 2008). The most important educational tool is to teach nurses and technicians how to recognize at-risk individuals and when to begin interventions so that they are early and effective. Methods: The project was implemented in a 50 bed Emergency Department. The project encompassed three separate goals. The first goal was to have the Braden Scale for Predicting Pressure Ulcer Score Risk added to the Initial Emergency Room Documentation forms. The second goal was to evaluate and then educate the emergency room nurses on the ability to recognize at-risk individuals for pressure ulcers and the interventions needed to prevent pressure ulcers. This goal was completed during a series of steps. First the nurses were given a pre-test to evaluate their knowledge on pressure ulcers. After the pre-test was completed and evaluated for learning needs, an educational learning presentation was given to the same nurses that had taken the pre-test. After the educational presentation a post-test was given and used to compare the nurses’ pre-test knowledge to the post-educational presentation knowledge. The purpose was to assess retention from the educational presentation and to determine if there were any new learning needs. The third goal of this project was completed concurrently with the above objectives. This final goal was to develop a Pressure Ulcer Screening Tool that was to be completed by the triage or charge/rescue squad nurse. After completion it was given to the primary emergency room nurse to alert them that an at-risk individual was entering their room and interventions needed to be implemented. Project Outcomes: The response from all involved was positive. The nurses mentioned that as long as it wasn’t a life threatening event, they thought about a patient’s skin, undressed them completely, completed the Braden Scale assessment tool and started interventions when appropriate. The manager, assistant managers and educator also noticed more patients were being completely undressed; mattress overlays were being used on regular emergency room stretchers when pressure redistribution mattresses were not available and the pressure ulcer checklist was given to the primary emergency room nurse to alert that this was an at-risk individual. Clinical Significance: Pressure ulcer prevention and treatment should start as early in the hospitalization process as possible. For many patients that means the Emergency Department. The awareness of risk factors, such as age, co-morbidities, nutritionally challenged individuals, limited mobility or immobility of patients is important for nurses to know and understand. The early prevention of pressure ulcers reduces pain, lengths of stay and complications for patients.